Increased provision of free childcare will not only help to lift the UK’s productivity, it will also raise household incomes – potentially improving health outcomes for children, explains Dr Brenda Gannon.
Currently, all children aged three or four are entitled to 15 hours of free childcare per week for 38 weeks. In last week’s Queen’s Speech it was announced that this will increase to 30 hours.
The aim is to provide affordable childcare and increase childcare provision for working families. More working families could lead to higher productivity. Much of the focus in the past week has been on how this can be funded, how much extra it will cost the state and whether even the current system is sustainable. In economics speak, the main issue is therefore opportunity cost: in a given budget, what else must we give up if more childcare places are provided?
Discussion on how this will benefit children – in terms of health, for example – has not emerged. But there is an important child health/parental income debate to be had that is based on answering the question, how does increased parental income improve children’s health?
Several academics have analysed this relationship and found that in general income is relevant for health up to age eight. Although it is still important thereafter, the impact is at a lower rate. This is because the early years are potentially the most important in setting-up a healthy lifestyle that will be embedded into a child’s life going forward. The public health white paper – Healthy Lives, Healthy People, 2010 – emphasised the importance of giving all children a healthy start to life.
Research to date has generally tested the relationship across four age groups: 0-3, 4-8, 9-12 and 13-17. In my current research, colleagues and I have questioned the appropriateness of these age categories and performed our own analysis on UK data and tested two innovative statistical methods. The good news is, we arrived at the same conclusions: income matters most up to age eight, continues to be important up to age 12, but decreases in relevance thereafter.
In addition, our research adds to this by finding a cohort effect from 2010 onwards – i.e. since then parents’ income has increasingly affected children’s health, for children aged 0-2. This means a higher income for parents is required for children born after 2010, compared to the income needed to gain the same level of health for those born before 2010, even after taking inflation into account. This begs another question, why is the focus of the new childcare hours on those aged three and four only?
Our findings are of direct relevance to the evolving debate on the widening of health income inequalities for children in England. The 0-2 age group is viewed as an important window of opportunity to make long term impacts on child nutritional status and health.
The Marmot Review – a strategic review to propose ways to reduce health inequalities in England post 2010 – stated that income-related health inequalities have been increasingly evident over the previous decade. To reduce this, there is a need for new initiatives that would aim to decrease how income affects health. Interventions are needed to improve health behaviour and should therefore be targeted more closely to those on lower incomes.
Given the strong relationship between parental income and child health, a number of strategic initiatives have been implemented over the last decade and these are continually improving. The more recent changes to policy indicate the greater need for careful intervention. For example, the Children and Young People’s Health benchmarking tool now sets new quality standards and clinical indicators relevant to the health and wellbeing of children and young people in an accessible way that supports local decision-making.
From October, local authorities will take over responsibility for planning and paying for public health services for babies and children up to age five years, with the aim of reducing health inequalities in each area. The impact of this, merged with doubling childcare hours, will be closely observed.
All these evolving policy interventions indicate to us that there is still a need for policies to reduce child health income inequality. Why is it that since 2010 there has been, we think, an increasing need for family incomes to support the health and well-being for children up to age two?
One possible answer is that socio-economic inequalities have become more common among women, according to Health Survey for England data used by the Marmot Review as part of the economic framework for analysing health inequalities in England. This reasoning was put forward by the economic task force and presented to the health inequalities commission.
Further research will be needed to understand the relationships between and mechanisms affecting income, health behaviour and outcomes. My conclusion is that there is a continuing need to integrate equity into priority setting. This means that the focus of the policy on doubling childcare hours should not be only the productivity of working parents. It should also consider the likely impact on health. This includes considering the future health of our children as adults – and how this will affect their productivity.
